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  • Question 1 - A 25-year-old man visits his general practitioner (GP), as he is concerned that...

    Incorrect

    • A 25-year-old man visits his general practitioner (GP), as he is concerned that he may have inherited a heart condition. He is fit and well and has no history of any medical conditions. However, his 28-year-old brother has recently been diagnosed with hypertrophic cardiomyopathy (HCM) after collapsing when he was playing football. The patient’s father died suddenly when he was 42, which the family now thinks might have been due to the same condition.
      Which of the following signs is most likely to be found in a patient with this condition?

      Your Answer: Ejection systolic murmur increased by squatting

      Correct Answer: Ejection systolic murmur decreased by squatting

      Explanation:

      Understanding the Ejection Systolic Murmur in Hypertrophic Cardiomyopathy: Decreased by Squatting

      Hypertrophic cardiomyopathy (HCM) is a condition characterized by asymmetrical hypertrophy of both ventricles, with the septum hypertrophying and causing an outflow obstruction of the left ventricle. This obstruction leads to an ejection systolic murmur and reduced cardiac output. However, interestingly, this murmur can be decreased by squatting, which is not typical for most heart murmurs.

      Squatting affects murmurs by increasing afterload and preload, which usually makes heart murmurs louder. However, in HCM, the murmur intensity is decreased due to increased left ventricular size and reduced outflow obstruction. Other findings on examination may include a jerky pulse and a double apex beat.

      While HCM is often asymptomatic, it can present with dyspnea, angina, and syncope. Patients are also at risk of sudden cardiac death, most commonly due to ventricular arrhythmias. Poor prognostic factors include syncope, family history of sudden death, onset of symptoms at a young age, ventricular tachycardia on Holter monitoring, abnormal blood pressure response during exercise, and septal thickness greater than 3 cm on echocardiogram.

      In summary, understanding the ejection systolic murmur in HCM and its unique response to squatting can aid in the diagnosis and management of this condition.

    • This question is part of the following fields:

      • Cardiology
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  • Question 2 - A 60-year-old man is seen at cardiology outpatients 6 weeks after an anterior...

    Correct

    • A 60-year-old man is seen at cardiology outpatients 6 weeks after an anterior myocardial infarction. His wife complains that she cannot sleep at night due to his constant coughing and throat clearing.
      Which medication is likely causing these symptoms?

      Your Answer: Perindopril

      Explanation:

      Common Side-Effects of Cardiovascular Medications

      Cardiovascular medications are commonly prescribed to manage various heart conditions. However, they can also cause side-effects that can affect a patient’s quality of life. Here are some common side-effects of popular cardiovascular medications:

      Perindopril: This medication can cause a dry, persistent cough, as well as hyperkalaemia, fatigue, dizziness, and hypotension.

      Amiodarone: Side-effects of this medication include dizziness, visual disturbance, unco-ordination, tremors, paraesthesia, deranged liver function tests (LFTs), deranged thyroid function tests (TFTs), and lung fibrosis.

      Atenolol: β-blockers like atenolol can cause fatigue, Raynaud’s phenomenon, bronchospasm, change in bowel habit, and sexual dysfunction.

      Atorvastatin: Statins like atorvastatin can cause myopathy/myositis, derangement of glucose control, and deranged LFTs.

      Candesartan: Angiotensin receptor blockers like candesartan can cause dizziness, headache, hyperkalaemia, and first-dose orthostatic hypotension. They are often prescribed to patients who are intolerant of ACE inhibitors due to dry cough.

      In conclusion, patients taking cardiovascular medications should be aware of these potential side-effects and report any concerns to their healthcare provider.

    • This question is part of the following fields:

      • Cardiology
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  • Question 3 - A 27-year-old woman is brought to the Emergency Department by ambulance from a...

    Incorrect

    • A 27-year-old woman is brought to the Emergency Department by ambulance from a music festival. It is a hot day and she had been standing in the crowd when she suddenly collapsed and lost consciousness. She is now fully alert and gives a history of feeling dizzy and nauseated before the collapse. She tells you that she is healthy, plays tennis for her local club and is a keen runner. She has had no previous episodes of losing consciousness. Her father has recently had a heart attack aged 60 years. Her resting electrocardiogram (ECG) shows a corrected QT interval of 400 ms and a slightly prolonged PR interval but is otherwise normal.
      What is the most likely diagnosis?

      Your Answer: Long QT syndrome

      Correct Answer: Vasovagal syncope

      Explanation:

      Differential Diagnosis for a Patient with Vasovagal Syncope

      Vasovagal syncope is a common cause of transient loss of consciousness. The hallmark of this condition is the three Ps – pallor, palpitations, and sweating. In patients with a history of vasovagal syncope, the ECG is typically normal. A prolonged PR interval may be seen in young athletes, but first-degree heart block rarely causes cardiac syncope. Ischemic heart disease is not a significant factor in this condition, and a family history of myocardial infarction is not relevant.

      If there are no features suggesting a more serious cause of transient loss of consciousness or a significant personal or family cardiac history, the patient can be discharged from the Emergency Department. However, they should be advised to seek medical attention if they experience any further episodes.

      Other conditions that may cause transient loss of consciousness include complete heart block, hypertrophic cardiomyopathy, substance misuse, and long QT syndrome. However, in this case, the patient’s history and ECG are not suggestive of these conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 4 - A 56-year-old man presents to the Emergency Department with chest pain. He has...

    Incorrect

    • A 56-year-old man presents to the Emergency Department with chest pain. He has a medical history of angina, hypertension, high cholesterol, and is a current smoker. Upon arrival, a 12-lead electrocardiogram (ECG) is conducted, revealing ST elevation in leads II, III, and aVF. Which coronary artery is most likely responsible for this presentation?

      Your Answer: Left coronary artery

      Correct Answer: Right coronary artery

      Explanation:

      ECG Changes and Localisation of Infarct in Coronary Artery Disease

      Patients with chest pain and multiple risk factors for cardiac disease require prompt evaluation to determine the underlying cause. Electrocardiogram (ECG) changes can help localise the infarct to a particular territory, which can aid in diagnosis and treatment.

      Inferior infarcts are often due to lesions in the right coronary artery, as evidenced by ST elevation in leads II, III, and aVF. However, in 20% of cases, this can also be caused by an occlusion of a dominant left circumflex artery.

      Lateral infarcts involve branches of the left anterior descending (LAD) and left circumflex arteries, and are characterised by ST elevation in leads I, aVL, and V5-6. It is unusual for a lateral STEMI to occur in isolation, and it usually occurs as part of a larger territory infarction.

      Anterior infarcts are caused by blockage of the LAD artery, and are characterised by ST elevation in leads V1-V6.

      Blockage of the right marginal artery does not have a specific pattern of ECG changes associated with it, and it is not one of the major coronary vessels.

      In summary, understanding the ECG changes associated with different coronary arteries can aid in localising the infarct and guiding appropriate treatment.

    • This question is part of the following fields:

      • Cardiology
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  • Question 5 - A 72-year-old woman visits her GP for a routine check-up. During the examination,...

    Incorrect

    • A 72-year-old woman visits her GP for a routine check-up. During the examination, she seems generally healthy but slightly fatigued and experiences some breathlessness at rest. Her pulse is irregularly irregular and measures 72 bpm, while her blood pressure is 126/78 mmHg. Upon further examination, no concerning issues are found. The patient has no significant medical history and is not taking any regular medications.
      What is the probable reason for this woman's development of atrial fibrillation (AF)?

      Your Answer: Ischaemic heart disease

      Correct Answer: Lone AF

      Explanation:

      Management of Atrial Fibrillation: The ABCD Approach

      Atrial fibrillation (AF) is a common arrhythmia that can be classified as paroxysmal, persistent, or permanent. Treatment options for AF depend on the classification and can be categorized into rate control, rhythm control, and anticoagulation. The ABCD approach is a useful tool for managing AF.

      A – Anticoagulation: Patients with AF are at an increased risk for thromboembolic disease, and anticoagulation should be considered in high-risk patients where the benefit outweighs the risk of hemorrhage.

      B – Better symptom control: Rate control is aimed at controlling the ventricular response rate to improve symptoms. Rhythm control is aimed at restoring and maintaining sinus rhythm to improve symptoms.

      C – Cardiovascular risk factor management: Management of underlying cardiovascular risk factors such as hypertension, diabetes, and hyperlipidemia can help reduce the risk of AF recurrence and complications.

      D – Disease management: Management of underlying conditions associated with AF, such as valvular heart disease and heart failure, can help improve AF outcomes.

      In summary, the ABCD approach to managing AF involves anticoagulation, better symptom control, cardiovascular risk factor management, and disease management. This approach can help improve outcomes and reduce the risk of complications in patients with AF.

    • This question is part of the following fields:

      • Cardiology
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  • Question 6 - A 59-year-old woman was recently diagnosed with essential hypertension and prescribed medication to...

    Incorrect

    • A 59-year-old woman was recently diagnosed with essential hypertension and prescribed medication to lower her blood pressure. However, she stopped taking the medication due to reported dizziness. Her blood pressure readings usually run at 150/100 mmHg. She denies any chest pain, shortness of breath, leg swelling, or visual problems. She has a history of occasional migraines but no other medical conditions. She has no known drug allergies. Her vital signs are within normal limits, other than high blood pressure. The S1 and S2 sounds are normal. There is no S3 or S4 sound, murmur, rub, or gallop. The peripheral pulses are normal and symmetric. The serum electrolytes (sodium, potassium, calcium, and chloride), creatinine, and urea nitrogen are within normal range. What is the most appropriate antihypertensive medication for this patient?

      Your Answer: Enalapril

      Correct Answer: Indapamide

      Explanation:

      The best medication for the patient in the scenario would be indapamide, a thiazide diuretic that blocks the Na+/Cl− cotransporter in the distal convoluted tubules, increasing calcium reabsorption and reducing the risk of osteoporotic fractures. Common side-effects include hyponatraemia, hypokalaemia, hypercalcaemia, hyperglycaemia, hyperuricaemia, gout, postural hypotension and hypochloraemic alkalosis.

      Prazosin is used for benign prostatic hyperplasia.

      Enalapril is not preferred for patients over 55 years old and can increase osteoporosis risk.

      Propranolol is not a preferred initial treatment for hypertension, and amlodipine can cause ankle swelling and should be avoided in patients with myocardial infarction and symptomatic heart failure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 7 - An 80-year-old man with aortic stenosis came for his annual check-up. During the...

    Incorrect

    • An 80-year-old man with aortic stenosis came for his annual check-up. During the visit, his blood pressure was measured at 110/90 mmHg and his carotid pulse was slow-rising. What is the most severe symptom that indicates a poor prognosis in aortic stenosis?

      Your Answer: Cough

      Correct Answer: Syncope

      Explanation:

      Symptoms and Mortality Risk in Aortic Stenosis

      Aortic stenosis is a serious condition that can lead to decreased cerebral perfusion and potentially fatal outcomes. Here are some common symptoms and their associated mortality risks:

      – Syncope: This is a major concern and indicates the need for valve replacement, regardless of valve area.
      – Chest pain: While angina can occur due to reduced diastolic coronary perfusion time and increased left ventricular mass, it is not as significant as syncope in predicting mortality.
      – Cough: Aortic stenosis typically does not cause coughing.
      – Palpitations: Unless confirmed to be non-sustained ventricular tachycardia, palpitations do not increase mortality risk.
      – Orthostatic dizziness: Mild decreased cerebral perfusion can cause dizziness upon standing, but this symptom alone does not confer additional mortality risk.

      It is important to be aware of these symptoms and seek medical attention if they occur, as aortic stenosis can be a life-threatening condition.

    • This question is part of the following fields:

      • Cardiology
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  • Question 8 - Various cardiac diseases necessitate the use of pacemakers to maintain regular heartbeats and...

    Correct

    • Various cardiac diseases necessitate the use of pacemakers to maintain regular heartbeats and sustain the patient's life. The following are three types of pacemakers, labeled 1-3: AAI, VVI, and DDD. Can you correctly match each pacemaker to the condition it is typically used to treat?

      Your Answer: AAI – sinus node dysfunction; VVI – AF; DDD – second-degree heart block

      Explanation:

      Understanding Pacemaker Coding and Indications

      Pacemakers are electronic devices that are implanted in the chest to regulate the heartbeat. They are used to treat a variety of heart conditions, including sinus node dysfunction, atrial fibrillation (AF), and heart block. Pacemakers are coded based on the chambers they pace, sense, and respond to, as well as their ability to modulate heart rate and provide multisite pacing.

      AAI pacemakers are used to pace the atria in patients with sinus node dysfunction and intact AV conduction. VVI pacemakers are used in patients with chronic atrial impairment, such as AF. DDD pacemakers are used to pace both the atria and ventricles in patients with second-degree heart block.

      It is important to note that AAI pacemakers would not be effective in treating ventricular systolic dysfunction, and DDD pacemakers cannot be used in the treatment of long QT syndrome. However, pacemakers can be used in long QT syndrome if clinically necessary, and DDD pacing may be appropriate for some patients with first-degree heart block.

      In summary, understanding pacemaker coding and indications is crucial for selecting the appropriate device for each patient’s unique heart condition.

    • This question is part of the following fields:

      • Cardiology
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  • Question 9 - A 28-year-old man comes to the clinic complaining of intermittent sharp central chest...

    Incorrect

    • A 28-year-old man comes to the clinic complaining of intermittent sharp central chest pains over the past 48 hours. The pain worsens with exertion and when he lies down. He reports no difficulty breathing. The ECG reveals widespread ST elevation.
      What is the most probable diagnosis?

      Your Answer: Ischaemic heart disease

      Correct Answer: Pericarditis

      Explanation:

      Distinguishing Pericarditis from Other Cardiac Conditions: A Clinical Overview

      Pericarditis is a common cause of widespread ST elevation, characterized by chest pain that is often pleuritic and relieved by sitting forwards. Other symptoms include dry cough, dyspnoea, and flu-like symptoms, with the most important sign being pericardial rub. It can be caused by viral infections, post-MI, tuberculosis, or uraemia.

      While pulmonary embolism may cause similar pleuritic pain, it would not result in the same ECG changes as pericarditis. Acute MI causes ST elevation in the affected coronary artery territory, with reciprocal ST depression. Hypertrophic cardiomyopathy presents with syncope or pre-syncope, and ECG changes consistent with left ventricular and septal hypertrophy. Ventricular aneurysm is another cause of ST elevation, but the clinical scenario and patient age align with a diagnosis of acute pericarditis.

      In summary, recognizing the unique clinical presentation and ECG changes of pericarditis is crucial in distinguishing it from other cardiac conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 10 - A newborn baby is found to have a heart murmur that is later...

    Incorrect

    • A newborn baby is found to have a heart murmur that is later identified as Ebstein's anomaly. Is it possible that a medication taken by the mother during pregnancy could have played a role in causing this congenital heart defect?

      Your Answer: Amiodarone

      Correct Answer: Lithium

      Explanation:

      Lithium Exposure During Pregnancy Linked to Ebstein’s Anomaly

      Exposure to lithium during pregnancy has been found to be linked to the development of Ebstein’s anomaly in newborns. Ebstein’s anomaly is a rare congenital heart defect that affects the tricuspid valve, which separates the right atrium and right ventricle of the heart. This condition can cause a range of symptoms, including shortness of breath, fatigue, and heart palpitations.

      Studies have shown that women who take lithium during pregnancy are at an increased risk of having a child with Ebstein’s anomaly. Lithium is commonly used to treat bipolar disorder, and while it can be an effective treatment, it is important for women who are pregnant or planning to become pregnant to discuss the risks and benefits of taking lithium with their healthcare provider.

      It is important for healthcare providers to be aware of the potential risks associated with lithium use during pregnancy and to closely monitor pregnant women who are taking this medication. Early detection and treatment of Ebstein’s anomaly can improve outcomes for affected infants.

    • This question is part of the following fields:

      • Cardiology
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  • Question 11 - An 82-year-old woman presents to her general practitioner with increasing shortness of breath...

    Incorrect

    • An 82-year-old woman presents to her general practitioner with increasing shortness of breath on exertion and swelling of her ankles and lower legs. During examination, she appears alert and oriented, but has significant erythema of her malar area. Her cardiovascular system shows an irregular heart rate of 92-104 beats per minute with low volume, and a blood pressure of 145/90 mmHg lying and standing. Her jugular venous pressure is raised with a single waveform, and her apex beat is undisplaced and forceful in character. There is a soft mid-diastolic murmur heard during heart sounds 1 + 2. Bibasal crackles are present in her chest, and she has pitting peripheral edema to the mid-calf. Based on these findings, what is the most likely cause of her collapse?

      Your Answer: Aortic stenosis

      Correct Answer: Mitral stenosis

      Explanation:

      Distinguishing Mitral Stenosis from Other Valvular Diseases: Exam Findings

      Mitral stenosis is a condition that presents with symptoms of left and right ventricular failure, atrial fibrillation, and its complications. When examining a patient suspected of having mitral stenosis, there are several significant signs to look out for. These include a low-volume pulse, atrial fibrillation, normal pulse pressure and blood pressure, loss of ‘a’ waves and large v waves in the jugular venous pressure, an undisplaced, discrete/forceful apex beat, and a mid-diastolic murmur heard best with the bell at the apex. Additionally, patients with mitral stenosis often have signs of right ventricular dilation and secondary tricuspid regurgitation.

      It is important to distinguish mitral stenosis from other valvular diseases, such as mixed mitral and aortic valve disease, aortic stenosis, aortic regurgitation, and mitral regurgitation. The examination findings for these conditions differ from those of mitral stenosis. For example, mixed mitral and aortic valve disease would not present with the same signs as mitral stenosis. Aortic stenosis presents with symptoms of left ventricular failure, angina, and an ejection systolic murmur radiating to the carotids. Aortic regurgitation causes an early diastolic murmur and a collapsing pulse on examination. Finally, mitral regurgitation causes a pan-systolic murmur radiating to the axilla. By understanding the unique examination findings for each valvular disease, healthcare professionals can accurately diagnose and treat their patients.

    • This question is part of the following fields:

      • Cardiology
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  • Question 12 - A 12-year-old girl is diagnosed with rheumatic fever after presenting with a 3-day...

    Correct

    • A 12-year-old girl is diagnosed with rheumatic fever after presenting with a 3-day history of fever and polyarthralgia. The patient’s mother is concerned about any potential lasting damage to the heart.
      What is the most common cardiac sequelae of rheumatic fever?

      Your Answer: Mitral stenosis

      Explanation:

      Rheumatic Fever and its Effects on Cardiac Valves

      Rheumatic fever is a condition caused by group A β-haemolytic streptococcal infection. To diagnose it, the revised Duckett-Jones criteria are used, which require evidence of streptococcal infection and the presence of certain criteria. While all four cardiac valves may be damaged as a result of rheumatic fever, the mitral valve is the most commonly affected, with major criteria including carditis, subcutaneous nodule, migratory polyarthritis, erythema marginatum, and Sydenham’s chorea. Minor criteria include arthralgia, fever, raised CRP or ESR, raised WCC, heart block, and previous rheumatic fever. Mitral stenosis is the most common result of rheumatic fever, but it is becoming less frequently seen in clinical practice. Pulmonary regurgitation, aortic sclerosis, and tricuspid regurgitation are also possible effects, but they are less common than mitral valve damage. Ventricular septal defect is not commonly associated with rheumatic fever.

    • This question is part of the following fields:

      • Cardiology
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  • Question 13 - A 50-year-old man who is a known alcoholic is brought to the Emergency...

    Incorrect

    • A 50-year-old man who is a known alcoholic is brought to the Emergency Department after being found unconscious. Over several hours, he regains consciousness. His blood alcohol level is high and a head computerised tomography (CT) scan is negative, so you diagnose acute intoxication. A routine chest X-ray demonstrated an enlarged globular heart. An echocardiogram revealed a left ventricular ejection fraction of 45%.
      What is the most likely cause of his cardiac pathology, and what might gross examination of his heart reveal?

      Your Answer: Alcohol and asymmetric hypertrophy of the interventricular septum

      Correct Answer: Alcohol and dilation of all four chambers of the heart

      Explanation:

      Alcohol and its Effects on Cardiomyopathy: Understanding the Relationship

      Alcohol consumption has been linked to various forms of cardiomyopathy, a condition that affects the heart muscle. One of the most common types of cardiomyopathy is dilated cardiomyopathy, which is characterized by the dilation of all four chambers of the heart. This condition results in increased end-diastolic volume, decreased contractility, and depressed ejection fraction. Chronic alcohol use is a significant cause of dilated cardiomyopathy, along with viral infections, toxins, genetic mutations, and trypanosome infections.

      Chagas’ disease, caused by trypanosomes, can lead to cardiomyopathy, resulting in the dilation of all four chambers of the heart. On the other hand, alcoholic cardiomyopathy leads to the dilation of all four chambers of the heart, including the atria. Alcohol consumption can also cause concentric hypertrophy of the left ventricle, which is commonly seen in long-term hypertension. Asymmetric hypertrophy of the interventricular septum is another form of cardiomyopathy that can result from alcohol consumption. This condition is known as hypertrophic cardiomyopathy, a genetic disease that can lead to sudden cardiac death in young athletes.

      In conclusion, understanding the relationship between alcohol consumption and cardiomyopathy is crucial in preventing and managing this condition. It is essential to limit alcohol intake and seek medical attention if any symptoms of cardiomyopathy are present.

    • This question is part of the following fields:

      • Cardiology
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  • Question 14 - An 82-year-old man presents with increasing shortness of breath, tiredness, intermittent chest pain...

    Incorrect

    • An 82-year-old man presents with increasing shortness of breath, tiredness, intermittent chest pain and leg swelling for the last 6 months. His past medical history includes hypertension, gout and a previous myocardial infarction 5 years ago. His current medications are as follows:
      diltiazem 60 mg orally (po) twice daily (bd)
      spironolactone 100 mg po once daily (od)
      allopurinol 100 mg po od
      paracetamol 1 g po four times daily (qds) as required (prn)
      lisinopril 20 mg po od.
      Given this man’s likely diagnosis, which of the above medications should be stopped?

      Your Answer: Allopurinol

      Correct Answer: Diltiazem

      Explanation:

      Medications for Heart Failure: Uses and Contraindications

      Diltiazem is a calcium channel blocker that can treat angina and hypertension, but it should be stopped in patients with chronic heart disease and heart failure due to its negative inotropic effects.

      Spironolactone can alleviate leg swelling and is one of the three drugs that have been shown to reduce mortality in heart failure, along with ACE inhibitors and β-blockers.

      Allopurinol is safe to use in heart failure patients as it is used for the prevention of gout and has no detrimental effect on the heart.

      Paracetamol does not affect the heart and is safe to use in heart failure patients.

      Lisinopril is an ACE inhibitor used to treat hypertension and angina, and stopping it can worsen heart failure. It is also one of the three drugs that have been shown to reduce mortality in heart failure. The mechanism by which ACE inhibitors reduce mortality is not fully understood.

    • This question is part of the following fields:

      • Cardiology
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  • Question 15 - A 57-year-old man arrives at the Emergency Department with sudden onset central crushing...

    Incorrect

    • A 57-year-old man arrives at the Emergency Department with sudden onset central crushing chest pain. The patient reports feeling pain in his neck and jaw as well. He has no significant medical history, but he does smoke socially and consumes up to 60 units of alcohol per week. An ECG is performed, revealing widespread ST elevation indicative of an acute coronary syndrome.
      What is the earliest point at which the microscopic changes of acute MI become apparent?

      Your Answer: 4-6 weeks

      Correct Answer: 12-24 hours after the infarct

      Explanation:

      The Pathological Progression of Myocardial Infarction: A Timeline of Changes

      Myocardial infarction, commonly known as a heart attack, is a serious medical condition that occurs when blood flow to the heart is blocked, leading to tissue damage and potentially life-threatening complications. The pathological progression of myocardial infarction follows a predictable sequence of events, with macroscopic and microscopic changes occurring over time.

      Immediately after the infarct occurs, there are usually no visible changes to the myocardium. However, within 3-6 hours, maximal inflammatory changes occur, with the most prominent changes occurring between 24-72 hours. During this time, coagulative necrosis and acute inflammatory responses are visible, with marked infiltration by neutrophils.

      Between 3-10 days, the infarcted area begins to develop a hyperaemic border, and the process of organisation and repair begins. Granulation tissue replaces dead muscle, and dying neutrophils are replaced by macrophages. Disintegration and phagocytosis of dead myofibres occur during this time.

      If a patient survives an acute infarction, the infarct heals through the formation of scar tissue. However, scar tissue does not possess the usual contractile properties of normal cardiac muscle, leading to contractile dysfunction or congestive cardiac failure. The entire process from coagulative necrosis to the formation of well-formed scar tissue takes 6-8 weeks.

      In summary, understanding the timeline of changes that occur during myocardial infarction is crucial for early diagnosis and effective treatment. By recognising the macroscopic and microscopic changes that occur over time, healthcare professionals can provide appropriate interventions to improve patient outcomes.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A 63-year-old man presents with increasing shortness of breath on exertion. On examination,...

    Incorrect

    • A 63-year-old man presents with increasing shortness of breath on exertion. On examination, bibasilar wet pulmonary crackles are noted with mild bilateral lower limb pitting oedema. His jugular vein is slightly distended. An S4 sound is audible on cardiac auscultation. An electrocardiogram (ECG) shows evidence of left ventricular (LV) hypertrophy. Chest radiography shows bilateral interstitial oedema without cardiomegaly.
      Which one of the following findings is most likely to be found in this patient?

      Your Answer: Impaired LV relaxation – normal LV end-diastolic pressure – normal LV end-systolic volume

      Correct Answer: Impaired LV relaxation – increased LV end-diastolic pressure – normal LV end-systolic volume

      Explanation:

      Understanding the Different Types of Left Ventricular Dysfunction in Heart Failure

      Left ventricular (LV) dysfunction can result in heart failure, which is a clinical diagnosis that can be caused by systolic or diastolic dysfunction, or both. Diastolic dysfunction is characterized by impaired LV relaxation, resulting in increased LV end-diastolic pressure but normal LV end-systolic volume. This type of dysfunction can be caused by factors such as LV hypertrophy from poorly controlled hypertension. On the other hand, impaired LV contraction results in systolic dysfunction, which is characterized by LV dilation, increased LV end-systolic and end-diastolic volumes, and increased LV end-diastolic pressure. It is important to differentiate between these types of LV dysfunction in order to properly diagnose and manage heart failure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 17 - A 7-year-old girl comes to the clinic complaining of headaches, particularly during times...

    Incorrect

    • A 7-year-old girl comes to the clinic complaining of headaches, particularly during times of stress or physical activity. She has no significant medical history. During her neurological exam, no abnormalities are found. However, a systolic murmur is heard along the length of her left sternal edge and spine. Her chest is clear and her blood pressure is 156/88 mmHg in her left arm and 104/68 mmHg in her left leg. An ECG reveals sinus rhythm with evidence of left ventricular hypertrophy. What is the most likely diagnosis?

      Your Answer: Atrial septal defect

      Correct Answer: Coarctation of the aorta

      Explanation:

      Coarctation of the Aorta and its Interventions

      Coarctation of the aorta is a condition where the aorta narrows, usually distal to the left subclavian artery. This can cause an asymptomatic difference in upper and lower body blood pressures and can lead to left ventricular hypertrophy. The severity of the restriction varies, with severe cases presenting early with cardiac failure, while less severe cases can go undiagnosed into later childhood.

      Interventions for coarctation of the aorta include stenting, excision and graft placement, and using the left subclavian artery to bypass the coarctation. An atrial septal defect and hypertrophic occlusive cardiomyopathy would not cause a blood pressure difference between the upper and lower body. Stress headaches and a flow murmur are not appropriate diagnoses for a child with hypertension, which should be thoroughly investigated for an underlying cause.

      In contrast, transposition of the great arteries is a major cyanotic cardiac abnormality that presents in infancy. It is important to diagnose and treat coarctation of the aorta to prevent complications such as left ventricular hypertrophy and cardiac failure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 18 - What are the components of Virchow's triad? ...

    Incorrect

    • What are the components of Virchow's triad?

      Your Answer: Venous thrombosis, injury to veins, blood hypercoagulability

      Correct Answer: Venous stasis, injury to veins, blood hypercoagulability

      Explanation:

      Virchow’s Triad and Its Three Categories of Thrombosis Factors

      Virchow’s triad is a concept that explains the three main categories of factors that contribute to thrombosis. These categories include stasis, injuries or trauma to the endothelium, and blood hypercoagulability. Stasis refers to abnormal blood flow, which can be caused by various factors such as turbulence, varicose veins, and stasis. Injuries or trauma to the endothelium can be caused by hypertension or shear stress, which can damage veins or arteries. Blood hypercoagulability is associated with several conditions such as hyperviscosity, deficiency of antithrombin III, nephrotic syndrome, disseminated malignancy, late pregnancy, and smoking.

      It is important to note that current thrombosis or past history of thrombosis and malignancy are not included in the triad. Malignancy is a specific procoagulant state, so it is covered under hypercoagulability. Virchow’s triad and its three categories of thrombosis factors can help healthcare professionals identify and manage patients who are at risk of developing thrombosis. By addressing these factors, healthcare professionals can help prevent thrombosis and its associated complications.

    • This question is part of the following fields:

      • Cardiology
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  • Question 19 - A radiologist examining a routine chest X-ray in a 50-year-old man is taken...

    Incorrect

    • A radiologist examining a routine chest X-ray in a 50-year-old man is taken aback by the presence of calcification of a valve orifice located at the upper left sternum at the level of the third costal cartilage.
      Which valve is most likely affected?

      Your Answer: The aortic valve

      Correct Answer: The pulmonary valve

      Explanation:

      Location and Auscultation of Heart Valves

      The heart has four valves that regulate blood flow through its chambers. Each valve has a specific location and can be auscultated to assess its function.

      The Pulmonary Valve: Located at the junction of the sternum and left third costal cartilage, the pulmonary valve is best auscultated at the level of the second left intercostal space parasternally.

      The Aortic Valve: Positioned posterior to the left side of the sternum at the level of the third intercostal space, the aortic valve is best auscultated in the second right intercostal space parasternally.

      The Mitral Valve: Found posteriorly to the left side of the sternum at the level of left fourth costal cartilage, in the fifth intercostal space in mid-clavicular line, the mitral valve can be auscultated to assess its function.

      The Valve of the Coronary Sinus: The Thebesian valve of the coronary sinus is an endocardial flap that plays a role in regulating blood flow through the heart.

      The Tricuspid Valve: Located behind the lower mid-sternum at the level of the fourth and fifth intercostal spaces, the tricuspid valve is best auscultated over the lower sternum.

      Understanding the location and auscultation of heart valves is essential for diagnosing and treating heart conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 20 - A 72-year-old man is brought by ambulance to the Accident and Emergency department....

    Incorrect

    • A 72-year-old man is brought by ambulance to the Accident and Emergency department. He is visibly distressed but gives a history of sudden onset central compressive chest pain radiating to his left upper limb. He is also nauseous and very sweaty. He has had previous myocardial infarctions (MI) in the past and claims the pain is identical to those episodes. ECG reveals an anterior ST elevation MI.
      Which of the following is an absolute contraindication to thrombolysis?

      Your Answer: Blood pressure of 180/100 mmHg

      Correct Answer: Brain neoplasm

      Explanation:

      Relative and Absolute Contraindications to Thrombolysis

      Thrombolysis is a treatment option for patients with ongoing cardiac ischemia and presentation within 12 hours of onset of pain. However, there are both relative and absolute contraindications to this treatment.

      Absolute contraindications include internal or heavy PV bleeding, acute pancreatitis or severe liver disease, esophageal varices, active lung disease with cavitation, recent trauma or surgery within the past 2 weeks, severe hypertension (>200/120 mmHg), suspected aortic dissection, recent hemorrhagic stroke, cerebral neoplasm, and previous allergic reaction.

      Relative contraindications include prolonged CPR, history of CVA, bleeding diathesis, anticoagulation, blood pressure of 180/100 mmHg, peptic ulcer, and pregnancy or recent delivery.

      It is important to consider these contraindications before administering thrombolysis as they can increase the risk of complications. Primary percutaneous coronary intervention is the preferred treatment option, but if not available, thrombolysis can be a viable alternative. The benefit of thrombolysis decreases over time, and a target time of <30 minutes from admission for commencement of thrombolysis is typically recommended.

    • This question is part of the following fields:

      • Cardiology
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